| NPI | 1811931140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 20005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC C38803002) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-06-11 |